| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,820 |
562 |
$112K |
| D1110 |
Prophylaxis - adult |
2,877 |
2,619 |
$111K |
| D0330 |
Panoramic radiographic image |
2,058 |
1,854 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,735 |
500 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,443 |
487 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,133 |
1,922 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,178 |
1,958 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,963 |
1,743 |
$32K |
| D1120 |
Prophylaxis - child |
1,415 |
1,245 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
385 |
176 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
217 |
$26K |
| D2335 |
|
207 |
76 |
$22K |
| D2394 |
|
227 |
139 |
$19K |
| D1351 |
Sealant - per tooth |
411 |
72 |
$9K |
| D2140 |
|
158 |
56 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
150 |
$4K |
| D1320 |
|
234 |
211 |
$4K |
| D2331 |
|
52 |
18 |
$3K |
| D0274 |
Bitewings - four radiographic images |
137 |
118 |
$3K |
| D2330 |
|
27 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
17 |
$185.76 |